A recent report on cancer care in England suggests patients should have access to a clinical nurse specialist (CNS) to help coordinate their care. The reasons for this are manifest.
Higher-educated nurses are associated with better patient outcomes, and cancer CNSs are highly experienced and trained to at least degree level. As clinical experts, they deliver evidence-based practice in a diverse range of specialties including screening, diagnostic services and site-specific cancers.
NHS England’s 2014 Cancer Patient Experience Survey (CPES), involving 70,141 patients, identified access to a CNS as most associated with higher patient scores and, as such, improved experience. This includes having access to cancer information and feeling involved in decisions about treatment and care.
A secondary study of responses to the 2010 CPES suggests a similar impact of the CNS role on improved emotional support and care coordination. It is consequently unsurprising that patient access to CNSs is within the six strategic priorities identified by the Independent Cancer Taskforce in its new cancer strategy for 2015-2020.
“CNS posts are in short supply in some organisations”
CNS posts are in short supply in some organisations. This could be because less-qualified staff are taking on aspects of the role, such as information delivery, or are employed to support CNSs. However, the diversity and complexity of the role cannot be underestimated, challenging suggestions that CNSs could be replaced by a more junior workforce.
A cancer diagnosis is often distressing, disrupting and confusing for patients and their family and friends, who struggle to make sense of it, make decisions and navigate the care system. Cancer CNSs proactively and holistically manage complex caseloads, often supporting patients through diagnosis, treatment, survivorship and palliative care.
They may avert unplanned admissions and are autonomous and knowledgeable about the disease, treatments and the psychological, social and financial impacts of a diagnosis.
“A cancer diagnosis is often distressing, disrupting and confusing for patients and their family and friends”
They also lead service redesign and oversee and coordinate services, all of which benefit patients.
They improve quality and the experience of care by reinforcing safety (reducing risks, ensuring safe services and rapid access to acute services), increasing productivity and efficiency (nurse led clinics, early side-effect management), and demonstrating leadership (teaching clinical colleagues, role modelling, innovation).
They also often lead the person-centred approach to multidisciplinary team treatment planning.
Patient-centred communication is said to be optimised when relationships are symbolised by reciprocal trust and respect rather than by merely imparting information.
“They develop ongoing therapeutic relationships that also facilitate communication between services”
These are the relationships cancer CNSs form with their patients, their family and friends. They develop ongoing therapeutic relationships that also facilitate communication between services. They exchange information with patients and families while taking account of shifting information and support requirements.
Cancer CNS’s deliver level two psychological interventions, assist patients in shared decision making about their treatment, and empower them to self-manage when they are ready to do so.
In summary, they are cost effective and benefit patients by driving improvements in care, being accessible, managing cases proactively, using their clinical expertise and acumen to reduce patient risk through early recognition of illness or recurrence, and reducing psychological distress.
Amanda Shewbridge is breast consultant nurse, Guy’s and St Thomas’ Foundation Trust Catherine Oakley is chemotherapy nurse consultant, Guy’s and St Thomas’ Foundation Trust, and president, UK Oncology Nursing Society